Asthma

Dr. Nouman Butt

Asthma
 Characterized by cough, chest tightness, dyspnea, and wheezing  It is caused by recurrent bronchospasm induced by either specific allergic stimuli or nonspecific irritant or physiochemical stimuli.  Chronic asthma can cause significant airway disease from Fibrotic changes associated with the inflammatory response

Asthma
 There is reasonable evidence that treating asthmatic with anti-inflammatory drugs may prevent long-term airway damage.  Preventing mast cells from degranulating, we can halt the damaging process instead of just opening up the airways with bronchodilators

Asthma
 Mast cells-they contain chemicals such as histamine ans serotonin which are released during inflammation and allergic responses.  Can occur in any age, mostly in childhood.  When asthma onset is early the prognosis is excellent. Often gone by puberty  Women have higher rate of occurrence in adulthood.

Asthma
 Physiologic change is airway obstruction due to bronchial smooth muscle spasm, mucous plugging, edema, and inflammation of the bronchial wall.  Airway narrowing causes in large airways cause wheezing.  When small airway are involved the predominant sx are dyspnea and cough.

Asthma
 Hx often provides the dx  Asthma should be suspected in unexplained episodes of dyspnea, cough, repeated chest colds, or bronchitis, particularly in childhood  Even cough itself may be a sx of asthma

Asthma
 Acute asthma


severity r/t frequency, duration, intensity, and response to previous medications, and their side effects, and sx free intervals. Chronic or continuous sx may cause confusion in dx of irreversible COPD.

 Chronic asthma


Asthma
 Family hx
  

asthma, atopic derm, environmental, stress use of ACE inhibitors and ASA smoking

Asthma
 Presentation of acute asthma
      

dyspnea, tachypnea use of accessory muscles flaring of nostrils expiration is prolonged cardiac dullness palpable liver edge

Chest X ray findings

 Increased bronchial wall markings (most characteristic)


Associated with thicker bronchial wall, inflammation Associated with chronic inflammation Associated with accessory muscle use

 Flattening of diaphragm
 

 Hyperinflation (variably present)  Patchy infiltrates (variably present) from Atelectasis

Image Asthma with upper lobe atelectasis

Asthma
 There are various types of asthma
        

Extrinsic Intrinsic Occupational Reactive airways dysfunction syndrome Exercise-induced bronchospasm Triad asthma Cough-variant asthma Allergic bronchopulmonary aspergillosis Intractable

Asthma
 Evaluation


Peak flow in the office can demonstrate bronchial hyperresponsiveness If asthma is expected please get a pulmonary consult! With exercise induced asthma management with bronchodilators alone If patients are using inhalers every day need inhaled anti-inflammatory

Asthma
 Treatment


Goal is to keep pt free of sx night and day, with full activity levels, normal lung function, and absent of side effects.

Asthma
 4 components of ambulatory management
   

Monitoring sx and lung function control of environmental triggers education of patient and family drug therapy

Asthma
 Home monitoring
 

Use of peak flow at home qd and record. If less than 80% of personal best then additional recordings during that day are needed Determine personal best after intensive asthma tx

Asthma
 Control of environmental triggers
    

smoking stress pollen NSAIDS need flu shot

Asthma
 Patient and family education
 

Use of peak flow Use of MDIs

Asthma
 Drug therapy-Normalize activity